FACTORS AFFECTING USE OF MEDICATION TO TREAT ALCOHOLISM

1995年1月，纳曲酮以REVIATM的名称上市，成为近50年来美国食品和药物管理局批准的第一种用于酒精中毒治疗的药物。在双盲随机临床试验中，纳曲酮作为治疗的辅助，在减少每周平均饮酒天数、复发频率和主观对酒精的渴望方面的疗效已经得到证实，而且副作用很少。尽管有证据表明其有效性，但有关其使用的报告表明，它并不像预期的那样广泛。一九九八年雷伟达的处方总数（包括麻醉治疗处方）为每月13,000张，仅略多于一九九六年的处方数目。1992年全国纵向酒精流行病学调查估计，在访谈前一年，有1370万成年人符合酒精滥用和酒精依赖的标准（Grant， 1995年）。为期一天的专业药物滥用提供者普查（NDATUS）表明，1996年，有67.7万名客户接受酒精中毒治疗。这一数字不包括在专门从事精神保健的机构和初级保健机构接受酒精中毒治疗的人。因此，可能只有2%接受酒精中毒治疗的人正在接受纳曲酮治疗。鉴于纳曲酮在其明显疗效面前的低使用率，了解采用这种重要的新药理学工具的障碍是至关重要的。本研究的目的是确定影响纳曲酮使用的因素，并深入了解从业人员对其疗效的认知。为此，本研究的主要目的是：(1)确定影响纳曲酮使用的因素及其相对重要性；(2)确定其他治疗酒精中毒的新药是否可能面临处方障碍；(3)确定医生用来克服纳曲酮处方障碍的方法；（四）收集服用纳曲酮的病人类别及服用纳曲酮的情况的资料。我们建议通过专家小组和对专门治疗药物滥用的医生进行全国调查来收集这些信息。

In January 1995, naltrexone, marketed under the name REVIATM became the first medication approved by the Food and Drug Administration for alcoholism treatment in almost 50 years. The ifficacy of naltrexone, as an adjunct to therapy, in decreasing the mean number of drinking days per week, the frequency of relapse, and subjective craving for alcohol with few side effects has been shown in double blind randomized clinical trials. Despite the evidence of its efficacy, reports of its use indicate that it is not as widespread as might be expected. Total prescription of Revia in 1998 (including prescription for narcotic treatment) were 13,000 per month, only slightly more than the number of prescriptions in 1996. The 1992 National Longitudinal Alcohol Epidemiologic Survey estimated that 13.7 million adults met the criteria for alcohol abuse and alcohol dependence during the year preceding the interview (Grant, 1995). The one-day census of specialty substance abuse providers (NDATUS) indicates that in 1996, there were 677,000 clients in treatment for alcoholism. This figure excludes persons receiving treatment for alcoholism in institutions specializing in mental health care and in primary care settings. Thus, perhaps only 2 percent of persons receiving alcoholism treatment are being treated with naltrexone. Given the low utilization of naltrexone in the face of its apparent efficacy, it is critical to understand the barriers to the adoption of this important new pharmacological tool. The goal of this proposed research is to identify the factors that are influencing the use of naltrexone and to gain insight into its perceived efficacy among practitioners. Towards this end, the primarily aims of this study are: (1) to identify factors influencing use of naltrexone and their relative importance; (2) to determine whether other new medications to treat alcoholism are likely to face barriers to prescribing; (3) to identify methods that physicians used to overcome barriers to prescribing naltrexone; (4) to collect information on the types of patients being prescribed naltrexone and the circumstances under which it is being prescribed. We propose to collect this information through experts panels and a national survey of physicians specialized in treating substance abuse.